Provider Demographics
NPI:1255899860
Name:MULLICAN, KLIRICIA M (OTR/L)
Entity type:Individual
Prefix:
First Name:KLIRICIA
Middle Name:M
Last Name:MULLICAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5282 E HIGHWAY 60
Mailing Address - Street 2:
Mailing Address - City:OWINGSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40360-8716
Mailing Address - Country:US
Mailing Address - Phone:269-352-0465
Mailing Address - Fax:
Practice Address - Street 1:5282 E HIGHWAY 60
Practice Address - Street 2:
Practice Address - City:OWINGSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40360-8716
Practice Address - Country:US
Practice Address - Phone:269-352-0465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-04
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY244615225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist